| Summary: | In general, the term "preeclampsia" refers to the presence of hypertension associated with
proteinuria occurring after 20 weeks of gestation in a previously non-proteinuric and
normotensive woman. A 24-year-old woman, known to be non-hypertensive, carried two
pregnancies and lost two babies. In 2011, as she was carrying the third (twin) pregnancy at
17 weeks of amenorrhea, she was admitted to the hospital for an 8-kilogram excess weight
gain between two antenatal visits spaced 4 weeks apart. The clinical examination revealed 140
mmHg systolic blood pressure and 80 mm Hg diastolic blood pressure. The following days,
the systolic blood pressure ranged between 110 and 120 mm Hg. Furthermore, the presence
of bilateral and symmetrical pitting edema of the lower limbs was reported. The laboratory
assessment upon admission showed the following results, proteinuria; 3.3 g/24 h, total albumin;
1.7 g/dL, total protein; 5.4 g/dL and total calcium was 75 g/L. The test results for HIV serology,
HBs antigen and HCV antibodies as well as antinuclear and native anti-DNA antibodies were
negative. The treatment consisted of iron, folic acid and calcium supplementation. Cesarean
section was scheduled for the 38th week. The immediate aftermath was simple. Formula
feeding was recommended for the newborns and ramipril 1.25 mg was initiated in the mother
once daily. The evolution was marked by a progressive reduction in proteinuria around 500
mg/24 h six months after delivery, and below 200 mg/24 h one year later. Pre-eclampsia
before 20 weeks of gestation is rare. Hypertension, which is its main clinical sign, may be
exceptionally absent at this stage.
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